MCC eLearning Drop Student Request Form

This form will submit a request to the eLearning Dept. to DROP a student from one of your class sections.

Please note:

The requested action WILL be executed with no further communication UNLESS the eLearning staff has a question about one or more details of the request.

ALL blanks of the form must be filled in or the form will not be submitted, and you will be prompted to complete the blank entries.

Allow at least One Business day for completion of the request.

Student Information:

Student ID: Student First Name: Student Last Name:

Course Section Information:

Subject Area (e.g. BIO, CSC, ART, etc.): 4-digit Level Code (e.g. 1126, 2246, etc.): Section Number (e.g. 8A, 9B, etc.):

Instructor (YOUR) Information:

Instructor ID: Instructor First Name: Instructor Last Name: Instructor Email Address (A copy of this submitted Form data will be sent to this email):

Drop Initiated by:

Instructor     If Instructor Initiated, state Drop reason:

Student        If Student-initiated: Has student submitted ANY work in the course?                       Yes   No

    Last Day Attended:

Instructor Digital Signature (enter your First and Last initials followed by your Birth Date as 6 digits e.g. jd021368):
Even though you initiated the request, the Digital Signature further confirms your concurrence with the proposed action.